Spring clip sterilization: one-year follow-up of 1,079 cases.

This is a report of 1,079 patients who underwent laparoscopic clip sterlization as of March, 1974. A one-year follow-up was obtained on 977 patients, or 90.5 per cent. Complications due to the clip technique appear limited to postoperative cramps for 24 to 48 hours in 26 per cent of patients. No ectopic pregnancies were detected. Pregnancies, when corrected for unsuspected existing pregnancies and surgical and manufacturing errors, occurred in 2 to 6 cases, for a method failure rate of 2 to 6/1,000. This report documents that experienced laparoscopists can perform this practice with local anesthesia, in combination with first-trimester abortion, and in hospital facilities other than an operating room.     

A recurrent cutaneous fistula secondary to the migration of a clip: report of a complication of tubal sterilization

The tubal sterilization is a safe and recognized sterilization method. The complications of this intervention are rare and mainly concern failure of surgical procedure or clip migrations. We report the first case of spontaneous migration of a clip behind the psoas followed by a chronic osteitis.     

Gamete intrafallopian transfer in a woman with tubal occlusion. A case report

Gamete intrafallopian transfer (GIFT) is usually performed when at least one fallopian tube is normally patent. We used GIFT in a case of bilateral tubal occlusion. The patient, who had primary ovarian failure, was enrolled in our GIFT program since it was assumed that her tubes were normally patent. Unexpectedly, at laparoscopy both tubes turned out to be distally occluded; nevertheless, GIFT was carried out by piercing the tubal wall. At this writing the patient had reached the 11th week of a normal intrauterine gestation and was still undergoing hormone replacement therapy.     

Sterilization by spring clip: a report of 1000 cases with a 6-month follow-up.

In September 1972, clinical trials of a spring-loaded clip for laparoscopic sterilization were begun and extended to a number of centers in the United States and overseas. As of March 1974, more than 1000 patients had undergone the procedure, usually performed under local anesthesia in an outpatient setting, with no fixed contraindications. Complications and pregnancy rates based on a preliminary 6-month follow-up are presented. Complications due to application of the clip appeared to be limited to postoperative cramps lasting 24 to 48 hours (26% of the patients). No ectopic pregnancies were reported. Pregnancies, when corrected for unsuspected pregnancies and misapplication of the clip, occurred in 2 of these first 1000 patients. The difficulties and relative contraindications learned from this unselected series and the advantages over electrocagulation techniques are discussed.     

Selective salpingography in cases of proximal tubal occlusion

The technical performance and results of selective salpingography (SGS) in 28 infertile women with proximal tubal occlusion (PTO) are presented. In 50 cases of PTO, diagnosed first by hysterosalpingography (HSG) and/or laparoscopy, 14 oviducts (28%) were patent during initial HSG using the baloon catheter tightly filling the internal cervical orificium and from remaining 36 tubes 27 (75%) were successfully recanalized by SGS. Three patients after successful SGS became pregnant. One of the pregnancies was ectopic. The SGS should be widely accepted in diagnosing and treatment of PTO as a cheap, simple, noninvasive and very effective method.     

Early assessment of a tubal plastic (Bleier) clip.

Fifty patients have been sterilized laparoscopically using a plastic tubal (Bleier) clip having a "snap-shut" mechanism. Initial assessment indicates that the method is simple in principle but there are limitations, including the bulky dimensions of the applicator, absence of a safety-catch mechanism, and faults in the clip design. Modifications are indicated before further evaluation.     

Microsurgical reversal of tubal sterilization: a report on 1,118 cases

Objective: To review and evaluate a series of patients who underwent microsurgical anastomosis of previously sterilized fallopian tubes.Design: Retrospective clinical study.Setting: Tertiary care academic center.Patient(s): In the 134–month span from January 1980 to February 1991, 1,118 women were evaluated for microsurgical reversal of previous tubal sterilization.Main Outcome Measure(s): Clinical characteristics of patients, pregnancy rates (PRs), and factors influencing the outcome.Result(s): Of 1,118 patients, 633 (56.6%) had been sterilized by laparoscopic cautery. Loss of children was a leading reason for requesting tubal reversal. The mean interval between tubal sterilization and reversal was 51.9 months. Nine hundred twenty-two (82.5%) patients were followed up for > 5 years. The overall PR after microsurgical tubal anastomosis was 54.8% (505 of 922) with a delivery rate of 72.5% (366 of 505), and the estimated anatomical success rate was 88.2% (814 of 922). There was no statistically significant difference in the PR or in the interval from tubal reversal to conception among the different operative procedure groups. In addition, no statistically significant difference in the PR was observed regardless of the postoperative tubal length. However, the interval from operation to pregnancy decreased significantly as the postoperative tubal length increased. The pregnant patients (n = 505) were younger and had a longer postoperative tube than the nonpregnant patients (n = 417); these differences were statistically significant.Conclusion(s): The pregnancy rate after microsurgical reversal of tubal sterilization was not significantly correlated with the method and duration of sterilization, the operative procedure, or the postoperative tubal length.     

Surgical treatment for distal tubal occlusion. A review of 167 cases

Surgery was performed on 167 patients for distal tubal occlusion. In 143 cases a terminal microsurgical salpingostomy was performed and in 24, a cuff neostomy. The overall intrauterine pregnancy rate was 20.4%, and 16.8% of the patients had live births. The ectopic gestation rate was 1.8%. None of the patients with a cuff neostomy became pregnant.     

Method failures of laparoscopic tubal sterilization in a residency training program. A comparison of the tubal ring and spring-loaded clip.

A prospective, randomized study of 365 women undergoing interval laparoscopic tubal sterilization in a residency training program was undertaken to compare method failures. Two occlusive techniques were compared, the spring-loaded clip (Hulka-Clemens) and the tubal ring (Falope Ring). Patients were randomized to either Falope Rings or Hulka-Clemens clips as the primary method. Demographic characteristics, educational level and operator experience were similar in the two groups. Follow-up at an average of 16 months (range, 6-24) revealed eight pregnancies (4.5%) in 176 women in the clip group and five pregnancies (2.6%) in the ring group. The Hulka-Clemens clip and the Falope Ring have similar incidences of method failure when employed by inexperienced operators. We question the usefulness of chromopertubation utilizing methylene blue dye to ensure proper placement of the occlusive device.     

Unilateral tubal twin pregnancy. A report of two cases

Unilateral tubal twin pregnancy is exceedingly rare: only 91 cases have been reported in the English literature to date. Two additional such cases are described.     

Histology: a prognostic factor in proximal tubal occlusion

To evaluate the results of 54 microsurgical anastomoses in relation to histologic findings, serial sections from 102 stenosed tubal portions (n = 54 women) were examined. The term pregnancy rate was 41% in our series. Unfavorable histologic factors influencing the postoperative pregnancy rate were revealed by our study: (1) chronic inflammation, (2) tubal inclusions in the tubal wall, and (3) tubal endometriosis.     

Two randomized controlled trials comparing the tubal ring and filshie clip for tubal sterilization

OBJECTIVE: To compare the effectiveness and safety of the Filshie Clip and Tubal Ring systems when applied via minilaparotomy and laparoscopy. DESIGN: Prospective, multicenter randomized controlled clinical trial, with postoperative evaluation by a physician who was masked to the operative technique. SETTING: Healthy volunteers in a variety of hospital settings. PATIENT(S): 2746 women (915 in the minilaparotomy study and 1831 in the laparoscopy study) who had requested permanent surgical sterilization. INTERVENTION(S): Surgical tubal ligation, using either Filshie Clips or Tubal Rings. A physician other than the surgeon evaluated the patients after the operation and again at 1, 6, and 12 months after surgery. MAIN OUTCOME MEASURE(S): Pregnancy rates and safety-related events. Result(s): During the 12 months after surgery, two women who received the Filshie Clip and two women who received the Tubal Ring became pregnant, giving a 12-month life-table pregnancy probability of 1.7 per 1000 women in both groups. The Tubal Ring was more difficult to apply and had higher rates of tubal or mesosalpingeal injuries at surgery. The Filshie Clip group had three cases of spontaneous clip expulsion during the follow-up period. CONCLUSION(S): Both the Filshie Clip and Tubal Ring are effective and safe for use in tubal occlusion.     

Vaginal expulsion of a Hulka clip. A case report.

The first known case of vaginal expulsion of a Hulka clip has occurred in a 35-year-old Ohio woman. The woman, gravida 5, para 4, abortus 1, underwent laparoscopic Hulka clip sterilization in January 1983, with no complications. She was seen again in March 1984 for symptomatic menometrorrhagia, for which dilation and curettage was performed. At her next gynecological visit in June 1987, the patient brought in a clamped Hulka clip that had been passed through the vagina. The uterus was normal in size, the adnexa were not palpable, and no fistula or iatrogenic openings were observed. The patient had not experienced severe abdominal pain, fever, or gastrointestinal disorder. A hysterosalpingogram showed bilateral blockage of the tubes and one clip on the left side. Clip self-migration should be considered an extremely rare complication of this procedure.     

Second-trimester tubal pregnancy: a case report

BACKGROUND: Second-trimester tubal pregnancy is an infrequent diagnosis, as these pregnancies often present with symptoms during the first trimester. CASE: A previously asymptomatic woman presented with pelvic pain and vaginal bleeding at 4 months' gestation and was found to have a live, 14-week, tubal pregnancy. CONCLUSION: Second-trimester symptoms, including nausea, vomiting, pelvic or abdominal pain, and vaginal bleeding, necessitate ultrasound to determine the pregnancy location, maintaining suspicion for a tubal or abdominal pregnancy.